Concepts in Nursing Research Methods

Critique standards

The factors used for this critique had been derived from related nursing literature (Feninstein & Horwitz, 1997; Cormack, 2000; Khan et al, 2003). A few dozen standards had been specified: design, pattern, inclusion/exclusion standards, timeframe of examine, knowledge assortment, reliability & validity, and knowledge evaluation.

Examine Design

Catlette (2005) used a qualitative design. Whereas this strategy has its deserves, principally a better diploma of realism and richer knowledge, it has various important drawbacks (Coolican, 1994). Observations are usually unreliable. In different phrases, if the identical nurses had been interviewed on a number of completely different events, about office violence, utilizing the identical open-ended interview protocol, their responses might differ considerably. Numerous biases creep in, usually brought on by situational components (e.g. open-ended questions, a really violent week adopted by a very calm week), or private issues (e.g. reminiscence deficits). Moreover there may be low inside validity. Which means that it's troublesome to ascertain with any certainty the connection between variables, because of the lack of statistical evaluation (which may estimate the chance that outcomes occurred by likelihood). For instance, Catlette’s interview knowledge suggests a hyperlink between office violence and emotions of vulnerability amongst nurses. Nevertheless, the extent to which the previous variable causes the latter can't be reliably established in a qualitative examine. Winstanley and Whittington (2004) benefit from the precision of a quantitative design. Whereas inside validity is excessive, the extent of realism is questionable. Individuals had been ‘pressured’ to answer predetermined questions (e.g. on bodily assault) utilizing a hard and fast response format (e.g. ‘As soon as’, ‘Greater than as soon as’). Thus, the information obtained was closely influenced by the sort of questions requested and the actual response format used. In the true world, well being care workers might understand the extent of aggression in phrases that don’t match the questionnaire format. For instance, a nurse might understand bodily assaults as ‘sporadic’ or ‘as soon as in a blue moon’. Since these categorisations weren’t obtainable within the questionnaire, the examine successfully lacks a sure diploma of realism. In a qualitative design, topics describe the world as they see it, somewhat than through phrases imposed by the researcher.

Pattern

Ideally a pattern ought to be randomly chosen in order that it's consultant of the inhabitants from which it was drawn, on this case nurses or well being care professionals. This enables findings from a single examine to be generalised to the broader neighborhood. Catlette (2005) used a comfort pattern, which means it wasn’t consultant of nurses on the whole. Granted there are appreciable sensible and logistic difficulties in attempting to recruit a random pattern of nurses. Their busy schedules and irregular shifts, for instance, hamper correct scientific choice. It's also fairly frequent for small comfort samples for use in qualitative research, since it's usually impractical to conduct in-depth interviews with massive teams. Nonetheless, Catlette’s findings, whereas related to the actual trauma centres concerned, are unlikely to use to nurses on the whole. This can be a severe limitation, since Catlette’s said goals counsel a common curiosity within the degree of violence in hospital emergency departments, somewhat than the actual trauma models from which topics had been drawn. Winstanley and Whittington (2004) additionally seem to have a used a comfort pattern: they merely invited well being care workers working in a common hospital, and who had common contact with sufferers, to take part. Though the goal pattern was fairly massive (a much bigger pattern improves illustration), solely a minority of workers really accomplished and returned questionnaires. All in all, contributors weren’t recruited randomly, due to this fact the findings can't be generalised to the broader inhabitants of well being care workers.

Inclusion/Exclusion Standards

Each research appeared to have clear inclusion/exclusion standards. Catlette (2005) solely recruited and interviewed nurses who had been registered, labored in a degree 1 trauma centre, and had skilled office violence. A transparent definition of what constituted violence was developed, serving to to minimise any ambiguities about eligibility. Winstanley and Whittington (2004) additionally specify inclusion standards. Solely well being care workers that had common and substantial contact with sufferers had been invited to take part. What constituted ‘common’ and ‘substantial’ contact was properly outlined (e.g. each day contact with sufferers). The benefit of getting clear inclusion/exclusion standards is that it helps the researcher recruit a homogenous pattern. If the contributors in a examine are too numerous, this successfully introduces extra sources of error that will obscure attention-grabbing themes, or relationships between variables. Findings could also be tougher to interpret. Nevertheless, a significant drawback of a homogenous pattern is that it's invariably ‘ad-hoc’, that's particular or distinctive, and therefore unlikely to mirror the broader neighborhood. Nonetheless, it may be argued that pattern homogeneity isn’t problematic if the broader neighborhood of curiosity precisely matches the inclusion/exclusion standards. For instance, Winstanley and Whittington’s (2004) examine was about affected person aggression in the direction of well being care workers. Thus, the inhabitants of curiosity was invariably going to be workers that had common contact with sufferers. On this respect the pattern chosen corresponds with the inhabitants of curiosity. Nevertheless, randomly deciding on nurses from the designate inhabitants would have supplied a consultant pattern that allows helpful generalisations. Merely utilizing volunteers, as Winstanley and Whittington did is unscientific.

Timeframe of examine

Winstanley and Whittington’s (2004) examine was successfully a retrospective (i.e. cross-sectional) survey. Which means that knowledge was collected at one time limit, particularly an Eight-week interval. Retrospective designs are thought-about inferior to potential (i.e. longitudinal) designs during which knowledge is collected on two or extra events, over a number of weeks, months, and even years (Coolican, 2004). This technique permits tentative causal inferences to be made – if a variable measured at Time 1 predicts or correlates with an element measured at Time 2, then there's a chance that former variable affected the latter, however not vice versa. Retrospective designs don’t permit for such inferences. Any correlations between variables are simply that – correlations! There isn't a sequence that will assist delineate potential causality. For instance, of their introduction and statements of examine goals, Winstanley and Whittington suggest that individual professions (e.g. nurses, docs) and hospital departments (e.g. medical, A & E) might elicit completely different ranges of bodily aggression skilled by workers. Thus, occupation/division gave the impression to be conceptualised as causal components. Nevertheless, though knowledge evaluation revealed relationships between these components and bodily aggression, there isn't a provision within the retrospective design to deduce causality, since all of the variables are measured concurrently. A potential technique during which occupation/division predicts experiences of bodily assault a number of weeks subsequently can be extra conclusive. Catlette (2005) doesn’t explicitly state the timeframe for her examine, albeit interviews usually take a number of days, weeks, or maybe months to finish. Notions of potential and retrospective designs are usually related to quantitative research, and barely utilized to qualitative analysis. It is because qualitative research are sometimes exploratory, merely in search of to determine attention-grabbing phenomena somewhat than set up causal relationships between variables. Nonetheless, interviewing contributors on two or extra separate events can be utilized to exhibit the robustness and reliability of any themes noticed. For instance, if the identical themes emerge throughout interviews performed at two completely different time limits, this may counsel that the themes are important somewhat than fleeting.

Knowledge Assortment

Catlette (2005) seems to have used semi-structured interviews for knowledge assortment (Coolican, 1994). By asking each interviewee pre-set however open-ended questions in a selected sequence, she prevented the inconsistency and sloppiness usually related to wholly unstructured (i.e. informal) interviews. It's potential the interviews had been casual however guided, which means that pre-set questions had been requested, albeit in no specific order. Both method, a guided or semi-structured interview suffers from sure constraints. Asking particular questions, albeit open-minded ones, restricts the interviewers flexibility to ask follow-up questions relying on the interviewees response. Interviews are additionally closely affected by interpersonal components, resembling lack of rapport, bodily attraction, and psychological manipulation. Winstanley and Whittington (2004) collected knowledge through a questionnaire. This technique has various limitations. One is the usually low response price. Of 1141 questionnaires posted out to contributors, solely 375 (33%) had been returned, denoting a substantial waste of sources. Usually the questionnaires returned symbolize an unusually eager sub-sample that will differ in key respects from the unique goal group. Which means that the researcher has to commit time and sources establishing what these variations are, and the way they may have an effect on the outcomes. Moreover, as a result of the ultimate pattern is smaller, statistical energy is lowered, rising the potential for a sort II error. One other limitation of questionnaires is using restricted (or ‘pressured selection’) response format. For instance, topics in Winstanley and Whittingtons’ (2004) examine had been pressured to select from three choices – ‘none’, ‘one’ or ‘multiple’. Thus, there isn't a room for contributors to qualify their solutions, for instance by declaring reminiscence lapses (e.g. ‘I can’t keep in mind’), or indicating ambiguous experiences (e.g. ‘unsure’). All in all, these restrictions scale back the realism and richness of knowledge collected. Interviewing topics on the identical points, however utilizing open-ended questions, will most likely yield slight completely different outcomes to these reported by Winstanley and Whittington (2004). One other limitation is that the majority of questionnaire communication is written. There isn't a provision to measure visible cues and gestures, which generally account for a lot of human communication, and even auditory cues. For instance, a frown or grunt, might signify a very traumatising experiencing, which merely can’t be detected from questionnaire responses. Lastly, questionnaires are sometimes accomplished within the absence of the researcher (e.g. postal questionnaire), making it troublesome to oversee the proceedings, or confirm whether or not the topic is identical one who accomplished the questionnaire. General, these constraints negate the conclusiveness of Winstanley and Whittington’s (2004) findings.

Knowledge Evaluation

According to customary process in qualitative analysis Catlette (2005) carried out thematic evaluation to determine recurring patterns within the knowledge. Significant data was extracted from the interview transcripts, after which themes had been recognized utilizing a coding system. Though a extremely helpful process, Braun and Clarke (2006) observe that thematic evaluation has sure disadvantages. One is the potential overlap between themes. Catlette identifies two themes – vulnerability and insufficient security measures. Classes, and subcategories reported counsel appreciable overlap between these dimensions (e.g. the sentiment ‘feeling unsafe’ might depict each emotions of vulnerability and an unsafe surroundings). One other weak spot is the excessive correspondence between the information assortment questions (i.e. interview information) and themes recognized. In different phrases, the themes reported merely mirror the questions requested throughout the interview (e.g. questions on security, resembling “How do you are feeling concerning the security of your office?” are sure to provide safety-related responses, and therefore themes). This implies very restricted analytic work was achieved to determine themes unbiased of the interview format. One other shortcoming of thematic evaluation is failure to include various or contradictive knowledge within the outcomes reported. Catlette provides little if any account of oddities within the knowledge that don’t essentially match the 2 rising themes. For instance, the interviews revealed that violence wasn’t a priority throughout interactions with co-workers. Clearly this revelation is incompatible with the notion of vulnerability and lack of security within the office. But, little is made from this inconsistency, making Catlettes’ somewhat ‘tidy’ themes seem somewhat suspicious. Few knowledge units in qualitative analysis are fully harmonious with no contradictions, so a examine that fails to report these oddities is extremely questionable. Winstanley and Whittington (2004) employed an inferential statistical take a look at to evaluation their knowledge, in line with the quantitative design of their examine. Chi-square was used to check for important traits within the frequency of bodily assaults as a perform of various well being care professionals (e.g. nurses and docs) and hospital departments (e.g. medical, surgical, A & E). Chi-square was applicable provided that the information was categorical (i.e. within the type of frequencies). Nevertheless, as a non-parametric take a look at, chi-square lacks sensitivity. This mixed with the restrictions of frequency knowledge (e.g. it fails to account for refined levels of variation between particular person topics or teams; for instance, asking nurses in the event that they’ve skilled aggression ‘as soon as’ or ‘greater than as soon as’ fails to bear in mind any variations within the depth and length of those aggressive episodes), will increase the chance of wrongly accepting the null-hypothesis.

Reliability & Validity

A serious methodological concern in scientific analysis is reliability and validity. Reliability refers back to the consistency of observations, whereas validity depicts the authenticity of observations. Each points are notably pertinent in qualitative research, because of the lack of construction, precision, and quantification. Catlette (2005) seems to have taken steps to boost reliability/validity. She stored a journal all through the length of the examine, as a way to determine any biases that will corrupt the information. Interviews had been performed utilizing a typical protocol, then the information was transcribed verbatim, and analysed utilizing common procedures. Nevertheless, these measures could also be insufficient. Coolican (1994) identifies a number of procedures for making certain good reliability, none of which seems to have been utilized by Catlette: triangulation, evaluation of detrimental circumstances, repetition of analysis cycle, and participant session. Triangulation entails verifying rising themes utilizing one other knowledge assortment technique apart from open-ended interviews. For instance a questionnaire measure of perceived office violence and security methods might have been administered or close-ended interviews performed. Knowledge from these various strategies might then be in contrast with the unique observations to gauge the diploma of consistency in rising themes. Evaluation of detrimental circumstances entails scrutinising circumstances that don’t match the rising themes. Repetition of analysis cycle entails repeatedly reviewing assumptions and inferences, to additional confirm rising themes. Lastly participant session entails speaking with contributors to see if observations from the examine match their very own experiences. None of those measures appear to have been utilized in Catlette’s examine, elevating severe considerations concerning the stability and authenticity of her observations. Winstanley and Whittington’s’ (2004) examine doesn’t seem to have fared a lot better. Though the numerical precision inherent in quantitative designs provides a point of reliability and validity, that is on no account assured, and must be demonstrated empirically. They fail to report any Cronbach Alpha reliability coefficients for the questionnaire used. Thus, it's unclear if the gadgets on this instrument had been internally constant. Take a look at-retest reliability wasn’t reported both, once more elevating questions concerning the consistency of contributors responses over time. A badly designed questionnaire (e.g. one with ambiguous statements, or grammatical errors) might simply confuse contributors, resulting in irregularities of their responses over time. No data on validity is supplied both. Usually, validity might be demonstrated by correlating knowledge from the questionnaire with knowledge from one other measure of experiences of aggression (a excessive correlation would point out good validity), submitting the questionnaire to a workforce of judges to establish if the content material addresses all types of human aggression (e.g. oblique types of aggression, resembling spreading rumours or social exclusion don’t seem to have been assessed), and even performing issue evaluation to ascertain assemble validity (i.e. confirm the size of aggression assumed to be measured by gadgets within the questionnaire). These inadequacies render the findings from Winstanley and Whittington’s (2004) examine inconclusive. For instance, the declare that aggression is “widespread” is questionable as a result of not all types of aggression had been measured.

General, each research are pretty categorical of their conclusions. Winstanley and Whittington (2004) surmise that their knowledge demonstrates the numerous ranges of aggression to which hospital workers are uncovered. Catlette (2005) reaches an identical conclusion, emphasising the vulnerability and lack of security perceived by nurses. Nevertheless, each research endure from varied analytic and methodological constraints. Maybe essentially the most severe of those is the obvious absence of reliability and validity measures that will reveal any volatility or misrepresentations within the knowledge. These limitations imply that any conclusions must be thought to be tentative, topic to additional analysis.

Bibliography

Braun, V. & Clarke, V. (2006) Utilizing thematic evaluation in psychology. Qualitative Analysis in Psychology, Three, pp.77-101.

Catlette, M. (2005) A descriptive examine of the perceptions of office violence and security methods of nurses working in Degree I trauma centres. Journal of Emergency Nursing, 31, 519-525.

Coolican, H. (1994) Analysis Strategies and Statistics in Psychology, London, Hodder & Stoughton.

Cormack, D. (2000) The Analysis Course of in Nursing: Fourth Version. London: Blackwell Science.

Eastabrooks, C.A. (1998) Will evidence-based nursing observe make observe excellent. Canadian Journal of Nursing Analysis. 30, pp.15-36.

Feninstein, A. R., & Horwitz, R. I. (1997) Issues within the “proof” of “evidence-based drugs. American Journal of Drugs 103, 529-535.

Khan, Ok., Kunz, R., Kleijnen, J. & Antes, G. (2003) Systematic Evaluations to Assist Proof-based Drugs: How you can Evaluation and Apply Findings of Healthcare Analysis. Oxford: Royal Society of Drugs Press.

Winstanley, S. & Whittington, R. (2004) Aggression in the direction of well being care workers in a UK common hospital: variation amongst professions and departments. Journal of Scientific Nursing, 13, pp.Three-10.

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